The Centers for Medicare & Medicaid Services (CMS) has ten Regional Offices (ROs) reorganized in a Consortia structure based on the Agency’s key lines of business: Medicare health plans, Medicare financial management, Medicare fee for service operations, Medicaid and children’s health, survey & certification and quality improvement. The intent of this structure is to improve performance through uniform issue management, consistent communication and leadership focused on achieving the Agency’s strategic action plan.

The Four Consortia

Each consortium is led by a Consortium Administrator (CA) who serves as the Agency’s national focal point in the Field for their business line(s) and as such is responsible for consistent implementation of CMS programs, policy and guidance across all ten regions for matters pertaining to their business line.  In addition to responsibility for a business line, each CA also serves as the Agency’s senior management official for two or three ROs, representing the CMS Administrator in external affairs matters and overseeing administrative operations.

The business lines, CAs, location of the consortium’s headquarters and the ROs for which the CA has responsibility for administrative operations and regional external affairs (REA) are as follows:

Consortium/Business Line Consortium Administrator

(CA)

 CA Location Senior Management Official
Consortium for Medicare Health Plans Operations (CMHPO) James T.Kerr New York Boston

New York

Philadelphia
Consortium for Financial Management and Fee for Service Operations (CFMFFSO) Nanette Foster Reilly Kansas City Kansas City

Denver

San Francisco
Consortium for Medicaid and Children’s Health Operations (CMCHO) Jackie Garner Chicago Chicago

Seattle
Consortium for Quality Improvement and Survey & Certification Operations (CQISCO) Randy Farris, M.D. Dallas Atlanta

Dallas

The Regional Administrators (RAs) in the six non-CA ROs including Boston, Philadelphia, Atlanta, Denver, San Francisco and Seattle are responsible for planning and implementing all external affairs initiatives within the geographic area with which they are affiliated.  Each RA reports to one of the four CAs.

The Associate Regional Administrators (ARAs) report directly to the CA responsible for the specific business line/functional area for which they are responsible (see organization charts).

Regional Offices – CMS’ Local Presence In Your Community

CMS central and ROs share a common vision and mission as well as a shared commitment to the five key objectives outlined in the CMS Strategic Plan 2008 – 2012:

1. Skilled, Committed, and Highly Motivated Workforce,

2. Affordable Health Care System,

3. High-Value Health Care,

4. Confident, Informed Consumers and

5. Collaborative Partnerships.

The ROs provide a capable, local presence necessary to achieve the Agency’s objectives and meet the constant challenges of serving approximately 90 million beneficiaries.  This role includes three key components: 1) representation, 2) protection and 3) monitoring.

Representation – By the very nature of our proximity to CMS beneficiaries and partners, the ROs play a key role in representing the Agency and delivering key messages.  Development and maintenance of regional, state and local partnerships, including those with beneficiary coalitions, professional associations and governmental entities as well as an understanding of local influences enable ROs to gain access and build collaborative partnerships that might otherwise be impossible.  These offices in the field also routinely collaborate with ROs of other Federal agencies to serve the health and human service needs of the public.

The CMS Field is a conduit of information.  These offices are constantly scanning and analyzing the regional, state and local health care marketplace and sharing their insights with central office.  They not only represent the Agency on a grassroots level, they also represent the grassroots to the Agency.  Information and data from the Field contributes to informed policymaking and solutions that make sense inside and outside the beltway.

Protection – The ROs put into practice on a regional, state and local level the protective regulations, policy and program guidance developed in central office.  They ensure protections are in place to facilitate the delivery of high-value health care that is safe, effective, efficient, patient centered, timely and equitable.

ROs implement action at the local level to safeguard the health and well-being of our beneficiaries and the trust fund.  Through ongoing customer service, patient advocacy and professional relations, they solve problems for beneficiaries, providers and other CMS stakeholders.

Monitoring – To achieve and maintain an affordable health care system, it is imperative that monitoring of CMS’ programs and evaluation of contractors/grantees is rigorous, accurate and timely.  Through ongoing monitoring of State Medicaid Agency financial claiming, state survey agencies, Managed Care Plans, Medicare claims processing contractors and peer review organizations, the ROs are the Agency’s front line in monitoring the implementation of CMS policies and regulations.

Source: http://www.cms.hhs.gov/RegionalOffices/

Related posts:

  1. Centers for Medicare and Medicaid Services (CMS) has ten Regional Offices (ROs) The Centers for Medicare & Medicaid Services (CMS) has ten Regional Offices (ROs) reorganized in a Consortia structure based on the Agency’s key lines of business: Medicare health plans, Medicare financial management, Medicare fee for service operations, Medicaid and children’s health, survey & certification and quality improvement. The intent of this structure is to improve […]...
  2. Centers for Medicare and Medicaid Services Centers for Medicare and Medicaid Services ...
  3. Related Issues Concerning Medicare and Medicaid Services Related Issues Concerning Medicare and Medicaid Services ...
  4. Medicare Expands List of Covered Preventive Services to Include HIV Screening Tests The Centers for Medicare & Medicaid Services (CMS) today announced its final decision to cover Human Immunodeficiency Virus (HIV) infection screening for Medicare beneficiaries who are at increased risk for the infection, including women who are pregnant and Medicare beneficiaries of any age who voluntarily request the service....
  5. Proposed rule entitled Medicaid Program; Coverage for Rehabilitative Services (72 FR 45201) proposed rule entitled Medicaid Program; Coverage for Rehabilitative Services (72 FR 45201)...
  6. Medicare Expands List of Covered Preventive Services to Include HIV Screening Tests The Centers for Medicare & Medicaid Services (CMS) today announced its final decision to cover Human Immunodeficiency Virus (HIV) infection screening for Medicare beneficiaries who are at increased risk for the infection, including women who are pregnant and Medicare beneficiaries of any age who voluntarily request the service. The decision is effective immediately....
  7. Medicare Card, NIH Funds 10 International Centers of Excellence for Malaria Research In an effort to accelerate the control of malaria and help eliminate it worldwide, the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health, today announced approximately $14 million in first-year funding to establish 10 new malaria research centers around the world....
  8. The following two categories of dental services are excluded from Medicare coverage A primary service (regardless of cause or complexity) provided for the care, treatment, removal, or replacement of teeth or structures directly supporting teeth, e.g., preparation of the mouth for dentures, removal of diseased teeth in an infected jaw....
  9. Nursing Home Compare provides quality ratings for each of the nation’s 16,000 Medicare and/or Medicaid-certified nursing homes. Nursing Home Compare provides quality ratings for each of the nation’s 16,000 Medicare and/or Medicaid-certified nursing homes. ...
  10. Medicare, Medicare Card, Study Finds Two Sling Surgeries, Equally Effective for Bladder Control in Women Two common operations for stress urinary incontinence (SUI) help women achieve similar levels of dryness, according to a team of urologists and urogynecologists who compared the treatments in a large U.S. trial supported by the National Institutes of Health. The study is being released online May 17, 2010, by the New England Journal of Medicine […]...
  11. Medicare – NIA Funds Centers to Study Demography of Aging The National Institute on Aging (NIA), part of the National Institutes of Health, today announced that it has committed more than $36.7 million over the next five years to support and expand its Centers on the Demography and Economics of Aging. The Centers form a network of universities and organizations leading innovative studies on the characteristics of the aging population. The awards, which include some support from the American Recovery and Reinvestment Act, renewed support for 11 Centers and established three new ones....
  12. Medicare Special Enrollment Period If you didn’t take Medicare Part B when you were first eligible because you or your spouse were working and had group health plan coverage ...
  13. Medicare Research, Songbird Genome Analysis, Reveals New Insights Into Vocal Behavior An international research consortium has identified more than 800 genes that appear to play a role in the male zebra finch's ability to learn elaborate songs from his father. The researchers also found evidence that song behavior engages complex gene regulatory networks within the brain of the songbird -- networks that rely on parts of the genome once considered junk....
  14. Medicare Coverage Database (MCD) contains all National Coverage Determinations (NCDs) The Medicare Coverage Database (MCD) contains all National Coverage Determinations (NCDs) and Local Coverage Determinations (LCDs), local policy articles, and proposed NCD decisions...
  15. NEW MEDICARE QUALITY DEMONSTRATIONS IN NORTH CAROLINA, INDIANA TO ADDRESS QUALITY IMPROVEMENT EFFORTS Two demonstrations comprised of a community-wide health information exchange in Indiana and a consortium of several community care physician networks in North Carolina are being implemented to encourage the delivery of improved quality care to an estimated 130,000 beneficiaries in those states, according to the Centers for Medicare & Medicaid Services (CMS)....